Background/Purpose:

Various infections play significant roles in flares of systemic lupus erythematosus (SLE). Hepatitis A virus is one of these infectious agents that has high endemicity particularly in developing countries. Hence, immunization via vaccination against this infectious agent would provide a better management of the disease. However, both immunosuppressive drugs and the disease itself are believed to impair the normal functioning of immune system. Little is known regarding the safety and immunogenicity of vaccinations in SLE patients. Moreover, to the best of our knowledge safety and efficacy of hepatitis A vaccination were not studied in children with SLE.

In the present study, we aimed to compare the antibody titers and seropositivity rates in juvenile SLE and healthy subjects after hepatitis A vaccination. Besides, we examined the effect of immunosuppressive drugs and disease activity on antibody responses.

Methods:

Sixty-nine juvenile SLE patients were enrolled in the study. Initially, we evaluated anti-HAV IgM and anti-HAV IgG titers in juvenile SLE patients. Of the 69 subjects, 37 patients were seronegative and eligible for hepatitis A vaccination. Among them, 7 juvenile SLE patients refused to participate to the study. Finally, anti-HAV Ig G negative 30 patients and 39 healthy subjects were vaccinated with two doses of hepatitis A vaccine (at 0 months and at sixth months). After vaccinations, anti-HAV Ig G titers were measured and compared between two groups.

Results:

Anti-HAV Ig G concentrations were measured after vaccination in 30 patients with juvenile SLE and 39 control subjects. Anti-HAV Ig G titer of the juvenile SLE patients was significantly lower than that of the healthy controls (median 4.6 versus 11.9 IU/L, p=0.02). Although the rate of seropositivity was lower in juvenile SLE patients (n=24/30, 80%) compared to healthy controls (n=33/39, 84.6%); this was not statistically significant (p=0.6). No adverse reaction was reported after vaccination.

Conclusion:

Although anti-HAV Ig G antibody titers after vaccination have found to be somewhat lower than that of the healthy subjects, significant portion of juvenile SLE patients were seropositive. According to these results, we conclude that hepatitis A vaccine is adequately immunogenic and quite safe in juvenile SLE patients.

References:

1. Borgia RE, Silverman ED. Childhood-onset systemic lupus erythematosus: an update. Curr Opin Rheumatol 2015; 27: 483-92.

2. Zandman-Goddard G, Shoenfeld Y. Infections and SLE. Autoimmunity 2005; 38: 473–85.

3. Melhem NM, Talhouk R, Rachidi H, Ramia S. Hepatitis A virus in the Middle East and North Africa region: a new challenge. Journal of viral hepatitis 2014; 21(9): 605-615.

4. Aytac MB, Kasapcopur O, Aslan M, Erener-Ercan T, Cullu-Cokugras F, Arisoy N. Hepatitis B vaccination in juvenile systemic lupus erythematosus. Clin Exp Rheumatol 2011; 29: 882-6.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/hepatitis-a-virus-vaccination-in-juvenile-onset-systemic-lupus-erythematosus/